Program Operations Manual System (POMS)

DI 10105.075 When The Five Month Waiting Period Is Not Required

Disability Insurance Benefit (DIB) claimants will not have to serve a waiting period if they had a prior period of disability (PPD) (see DI 10105.001 - Period of Disability) that terminated within 5 years (60 months) before the current period of disability began.

IMPORTANT: See NOTE: in DI 11015.020C.2. regarding a circumstance that does not require disability to exist throughout the month.

NOTE: If a Medicare for Qualified Government Employment (MQGE) beneficiary subsequently becomes insured for DIB, the MQGE period is not treated as a prior period of DIB. The deemed waiting period in the MQGE entitlement does not satisfy the requirement for serving a title II DIB waiting period, even if MQGE entitlement is continuing when a period of title II DIB is established. DIB waiting period instructions are in DI 10105.070.

Eligibility for benefits begins with the first month within the effective life of the application, after 8/60:

throughout which he/she is under a disability, and

has DIB insured status.

If the NH does not have DIB insured status in the month the current disability begins, he/she will not be eligible for a DIB until the first month thereafter in which such insured status exists. (In these situations the first day of the first month of the qualifying quarter will become the established onset date.)

EXAMPLE # 1

Mike Randolph's period of disability terminated 11/30/97, as he was no longer disabled. He filed for a new period of disability on 2/18/04. The DDS established he was disabled on 8/14/02. However, Mr. Randolph did not have insured status in 8/02. He does not meet fully insured status until the 6/03 quarter. His onset date is established as 4/1/03, the first day of the first month of the qualifying quarter. Mr. Randolph must serve a new waiting period, as more than 5 years (60 months) had elapsed between the dates his prior period of disability terminated (11/30/97) and his new disability onset (4/1/03). Mr. Randolph's first month of entitlement to a disability benefit would be 9/03.

EXAMPLE # 2

Mary Jones' period of disability terminated 12/30/99, as she was no longer disabled. She filed for a new period of disability January 2001. The DDS determined she was under a disability beginning 12/1/00. She meets insured status at that time. Mrs. Jones does not have to serve a new waiting period as less than 5 years (60 months) had elapsed between the time her prior period of disability terminated (12/30/99) and her new disability onset (12/1/00). Mrs. Jones' first month of entitlement to a disability benefit would be 12/00.

The 60–month period begins with the month in which DIB terminated or the prior freeze ceased, i.e., the month after the last month of entitlement. The T8 month on the MBR History line or the DBC entry on the DIB line is the first month counted for the 60–month period. For example, if the last payment was for 11/06. the 60–month period would be 12/06 through 11/11.

The ending date of the 60-month period is the last day of the 60th calendar month after the end of the prior DIB entitlement or the end of the prior freeze period. If a new period of disability is established within the 60–month period mentioned above, the period ends with the month before the first month throughout all of which the NH is under a disability.

Where the current disability begins on the first day of a month, the period will end with the preceding month. If it begins on other than the first day of a month, the period will end with the month in which the current disability began.

Example:

Michael Randolph’s period of disability terminated 11/30/00 (12/00 is the T8 month on the MBR History line and the DBC entry on the DIB line) as he was no longer disabled. The 60 month period would be 12/00 through 11/05. He filed for a new period of disability on 2/18/2006. The DDS established he was disabled on 8/14/2005. Mr. Randolph does not have to serve a waiting period because his new period of disability, the date of onset, falls within the 60 month period. Mr. Randolph’s entitlement date would be 09/05.